Dunne Richard F, Crawford Jeffrey, Smoyer Karen E, McRae Thomas D, Rossulek Michelle I, Revkin James H, Tarasenko Lisa C, Bonomi Philip D
Department of Medicine and Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA.
Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1628-1640. doi: 10.1002/jcsm.13510. Epub 2024 Aug 2.
Cancer-associated cachexia is a multifactorial wasting disorder characterized by anorexia, unintentional weight loss (skeletal muscle mass with or without loss of fat mass), progressive functional impairment, and poor prognosis. This systematic literature review (SLR) examined the relationship between cachexia and survival in patients with colorectal or pancreatic cancer in recent literature. The SLR was conducted following PRISMA guidelines. Embase and PubMed were searched to identify articles published in English between 1 January 2016 and 10 October 2021 reporting survival in adults with cancer and cachexia or at risk of cachexia, defined by international consensus (IC) diagnostic criteria or a broader definition of any weight loss. Included publications were studies in ≥100 patients with colorectal or pancreatic cancer. Thirteen publications in patients with colorectal cancer and 13 with pancreatic cancer met eligibility criteria. Included studies were observational and primarily from Europe and the United States. Eleven studies (42%) reported cachexia using IC criteria and 15 (58%) reported any weight loss. An association between survival and cachexia or weight loss was assessed across studies using multivariate (n = 23) or univariate (n = 3) analyses and within each study across multiple weight loss categories. Cachexia/weight loss was associated with a statistically significantly poorer survival in at least one weight loss category in 16 of 23 studies that used multivariate analyses and in 1 of 3 studies (33%) that used univariate analyses. Of the 17 studies demonstrating a significant association, 9 were in patients with colorectal cancer and 8 were in patients with pancreatic cancer. Cachexia or weight loss was associated with significantly poorer survival in patients with colorectal or pancreatic cancer in nearly two-thirds of the studies. The classification of weight loss varied across and within studies (multiple categories were evaluated) and may have contributed to variability. Nonetheless, awareness of cachexia and routine assessment of weight change in clinical practice in patients with colorectal or pancreatic cancer could help inform prognosis and influence early disease management strategies.
癌症相关性恶病质是一种多因素导致的消耗性疾病，其特征为厌食、非故意体重减轻（骨骼肌质量减少，伴有或不伴有脂肪质量减少）、进行性功能障碍和预后不良。本系统文献综述（SLR）在近期文献中研究了恶病质与结直肠癌或胰腺癌患者生存率之间的关系。该SLR按照PRISMA指南进行。检索了Embase和PubMed，以识别2016年1月1日至2021年10月10日期间以英文发表的报告癌症和恶病质患者或有恶病质风险患者生存率的文章，这些患者根据国际共识（IC）诊断标准或任何体重减轻的更宽泛定义进行定义。纳入的出版物为针对≥100例结直肠癌或胰腺癌患者的研究。13篇关于结直肠癌患者的出版物和13篇关于胰腺癌患者的出版物符合纳入标准。纳入的研究为观察性研究，主要来自欧洲和美国。11项研究（42%）使用IC标准报告恶病质，15项研究（58%）报告任何体重减轻情况。使用多变量分析（n = 23）或单变量分析（n = 3）在各项研究中评估生存率与恶病质或体重减轻之间的关联，并在每项研究中针对多个体重减轻类别进行评估。在使用多变量分析的23项研究中的16项以及使用单变量分析的3项研究中的1项（33%）中，恶病质/体重减轻在至少一个体重减轻类别中与统计学上显著较差的生存率相关。在显示有显著关联的17项研究中，9项针对结直肠癌患者，8项针对胰腺癌患者。在近三分之二的研究中，恶病质或体重减轻与结直肠癌或胰腺癌患者显著较差的生存率相关。体重减轻的分类在不同研究之间以及同一研究内部存在差异（评估了多个类别），这可能导致了变异性。尽管如此，在结直肠癌或胰腺癌患者的临床实践中认识恶病质并对体重变化进行常规评估，可能有助于判断预后并影响早期疾病管理策略。
